ANOREXIA NERVOSA:CLINICAL FEATURES AND ENDOCRINOLOGY

The focus of the research is the study of patients with eating disorders. Within the last year we have begun to focus more specifically on patients with the binge eating syndrome known as bulimia. Some of these patients have anorexia nervosa, some have histories of anorexia nervosa, and others are, and have always been, of normal weight. Many clinicians have noted that patients with eating disorders in general and with bulimia in particular complain of mood disturbances. We have been interested in determining to what degree patients with bulimia have affective disturbances which resemble those of depressed patients without eating disturbances, and to what degreee treatments known to be effective for major affective illness are also effective in the treatment of eating disorders. Finally, we wish to determine how many patients of normal weight with bulimia have hormonal disturbances which resemble those of underweight patients with anorexia nervosa, or normal weight patients with major affective illness. We have initiated a double-blind placebo-controlled study of the monoamine oxidase inhibitor antidepressant, phenelzine, in the treatment of normal weight outpatients with bulimia. The results demonstrate that phenelzine is substantially more effective than placebo in the treatment of such patients. One goal for the coming year is to include additional subjects in the study so that we will be able to identify pre-treatment characteristics of patients who respond to phenelzine and to determine to what degree a positive response to the drug is related to relief of depression. Because of the presence of prominent anxiety among patients with bulimia and a report of histories of panic attacks in many bulimic patients, we will carry out lactate infusions to determine what fraction of bulimic patients experience lactate-induced panic attacks. Finally, we are carrying out assessments of the hypothalamic-pituitary adrenal axis in normal weight patients with bulimia to see to what degree they show increased levels of cortisol secretion and if this is related to their mood, weight fluctuation, or underlying diagnosis.